WO2018043279A1 - Cathéter d'aspiration, système d'aspiration et procédé de traitement - Google Patents

Cathéter d'aspiration, système d'aspiration et procédé de traitement Download PDF

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Publication number
WO2018043279A1
WO2018043279A1 PCT/JP2017/030306 JP2017030306W WO2018043279A1 WO 2018043279 A1 WO2018043279 A1 WO 2018043279A1 JP 2017030306 W JP2017030306 W JP 2017030306W WO 2018043279 A1 WO2018043279 A1 WO 2018043279A1
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WO
WIPO (PCT)
Prior art keywords
distal
suction
proximal
expansion
thrombus
Prior art date
Application number
PCT/JP2017/030306
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English (en)
Japanese (ja)
Inventor
千田高寛
今井正臣
増渕雄輝
北岡孝史
金本和明
Original Assignee
テルモ株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by テルモ株式会社 filed Critical テルモ株式会社
Publication of WO2018043279A1 publication Critical patent/WO2018043279A1/fr
Priority to US16/288,425 priority Critical patent/US11065020B2/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/32075—Pullback cutting; combined forward and pullback cutting, e.g. with cutters at both sides of the plaque
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22039—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire eccentric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A61B2017/22047—Means for immobilising the guide wire in the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22079—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with suction of debris
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B2017/320716—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions comprising means for preventing embolism by dislodged material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00—General characteristics of surgical instruments
    • A61B2217/002—Auxiliary appliance
    • A61B2217/005—Auxiliary appliance with suction drainage system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A61M25/007—Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0074—Dynamic characteristics of the catheter tip, e.g. openable, closable, expandable or deformable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082—Catheter tip comprising a tool
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M29/00—Dilators with or without means for introducing media, e.g. remedies
    • A61M29/02—Dilators made of swellable material

Definitions

  • the present invention relates to a suction catheter and a suction system inserted into a living body lumen, and a treatment method using the suction system.
  • pain or swelling may occur when a part of a vein is clogged with blood clots.
  • this treatment there is a method of percutaneously inserting the device and physically crushing and removing the thrombus.
  • a thrombolytic agent is used before and / or during the treatment, or the detached thrombus is sucked and removed as much as possible during the treatment.
  • an exfoliated thrombus having a clinically problematic size may reach the lung or the like.
  • Patent Document 1 describes a method in which a filter for collecting a thrombus is installed at a distal portion of a long wire, and a suction catheter for sucking the thrombus is inserted on the proximal side. Yes.
  • the suction catheter is guided to a target position along a wire fixed to the filter.
  • the suction catheter sucks the thrombus collected by the filter and removes it from the body.
  • the suction catheter has a main suction hole on an end surface perpendicular to the central axis on the distal side. For this reason, in the suction catheter, a thrombus having a diameter larger than the diameter of the suction lumen of the suction catheter may block the suction hole, and the thrombus or the like may not be effectively removed. Also, the position of the suction catheter relative to the filter varies depending on the operator. For this reason, the procedure is not stable depending on the skill of the technician.
  • the present invention has been made to solve the above-described problems, and provides an aspiration catheter, an aspiration system, and a treatment method capable of effectively removing an object flowing in a living body lumen and providing a stable procedure. For the purpose.
  • An aspiration catheter that achieves the above-described object is an aspiration catheter that can be inserted into a living body lumen to suck an object in the living body lumen, and is located on the distal side of the tubular base portion and the base portion.
  • a distal opening that is inclined with respect to a central axis is provided, and the distal opening is opened in a direction opposite to an inclination direction of the distal tubular portion with respect to the base.
  • An aspiration system that achieves the above object is an aspiration system that is inserted into a living body lumen and capable of collecting and sucking an object in the living body lumen, and includes a long shaft portion and a plurality of gaps.
  • An expansion part that is an elastically deformable cylinder, a proximal connection part that is provided on the proximal side of the extension part and is fixedly or movably connected to the shaft part, and the shaft
  • a suction catheter provided with a suction lumen for movably accommodating the part and applying a suction force, the suction catheter being located on a distal side of the base and the base
  • Another suction system that achieves the above object is a suction system that is inserted into a living body lumen and capable of collecting and sucking an object in the living body lumen, and includes a long shaft portion and a plurality of gaps.
  • An extension part that is an elastically deformable cylinder, and a proximal side connection part that is provided on the proximal side of the extension part and is fixedly or movably connected to the shaft part,
  • a suction catheter that movably accommodates the shaft portion and is provided with a suction lumen for applying a suction force, the suction catheter being positioned on a distal side of the tubular base portion and the base portion A distal distal tubular portion that is inclined in a predetermined direction with respect to a central axis of the base portion, the distal tubular portion being a distal end portion and the proximal connecting portion being A distal opening to enter, and a proximal side of the distal opening.
  • a suction hole that opens at a surface wherein an opening area of the suction hole is larger than a cross-sectional area of the suction lumen, and the suction hole is in a direction opposite to an inclination direction of the distal tubular portion with respect to the base portion Open to face.
  • a treatment method for achieving the above object is a treatment method for collecting and sucking an object in a living body lumen using the above suction system, wherein the expansion portion connected to the shaft portion is a living body.
  • the opening area of the suctionable opening of the suction catheter is larger than the cross-sectional area of the suction lumen. For this reason, a wide range can be sucked, a large object can be sucked, and the object can be sucked effectively.
  • the suction side opening of the suction catheter can be sucked while being in contact with a device that collects an object within the living body lumen, a stable procedure that does not depend on the operator can be provided.
  • FIG. 5 is a cross-sectional view taken along line AA in FIG. 4.
  • FIG. 5 is a sectional view taken along line BB in FIG. 4. It is sectional drawing which shows the expansion part and closing part in a natural state.
  • FIG. 1 It is sectional drawing which shows the expansion part and closed part in a return state. It is a figure which shows the distal part of a suction catheter, (A) is a top view, (B) is sectional drawing. It is a top view which shows the crushing device. It is sectional drawing which shows the state in the blood vessel, (A) shows the state at the time of inserting an expansion part in the blood vessel, (B) shows the state which expanded the expansion part in the blood vessel. It is sectional drawing which shows the state in the blood vessel, (A) is the state which left the expansion part in the folded state, and is indwelling in the blood vessel, (B) shows the state which inserted the crushing device in the blood vessel.
  • the suction system 1 is used to partially suppress the flow in the blood vessel in order to suck and remove objects such as thrombus and plaque in the blood vessel.
  • the side of the device to be inserted into the blood vessel is referred to as “distal side”, and the proximal side for operation is referred to as “proximal side”.
  • the object to be removed is not necessarily limited to a thrombus or a plaque, and any object that can exist in a living body lumen can be applicable.
  • the source side of the blood flow in the blood vessel is referred to as “upstream side”, and the side to which the blood flow is directed is referred to as “downstream side”.
  • the suction system 1 includes an expansion device 10 that restricts blood flow in a blood vessel, a suction catheter 30 that can store the expansion device 10, and an expansion. And a pressing shaft 40 used to push the instrument 10 out of the suction catheter 30. Restricting blood flow is to partially block a cross section perpendicular to the axis of the blood vessel or to reduce the blood flow by reducing the cross section.
  • the expansion device 10 includes an expansion portion 20 that is a net-like cylinder having a plurality of gaps 21 ⁇ / b> A, a closing portion 70 disposed on the inner peripheral surface of the expansion portion 20, and the expansion portion 20.
  • a long shaft part 24 connected to the auxiliary part 80 and an auxiliary extension part 80 provided on the distal side of the extension part 20.
  • the shaft portion 24 is a long wire that penetrates the extension portion 20 from the hand and extends to the auxiliary extension portion 80.
  • the constituent material of the shaft portion 24 is not particularly limited, for example, stainless steel, a shape memory alloy, or the like can be suitably used.
  • the expansion part 20 is a part that functions as a filter to collect thrombus and the like.
  • the extended portion 20 is fixedly connected to a shaft portion 24 and a plurality of flexible deformable linear bodies 21 that are braided in a net shape so as to form a cylindrical body having a gap 21 ⁇ / b> A.
  • a distal connection portion 50 and a proximal connection portion 60 slidably connected to the shaft portion 24.
  • the plurality of linear bodies 21 have a gap 21A between the linear bodies 21 by braiding.
  • the film-like closure part 70 is being fixed to the internal peripheral surface of a proximal part.
  • the extension part 20 has a structure in which the distal part and the proximal part are asymmetric.
  • the part where the closing part 70 of the extension part 20 is not fixed is easier to deform than the part where the closing part 70 of the extension part 20 is fixed.
  • the extension part 20 may have a structure in which the distal part and the proximal part are symmetrical.
  • the distal connection portion 50 includes an inner tube 51 positioned inside the linear body 21 and an outer tube 52 positioned outside the linear body 21. Between the inner tube 51 and the outer tube 52, the distal end portion of the linear body 21 and the shaft portion 24 are sandwiched and fixed. An inner surface side of the inner tube 51 is a guide wire lumen 54 into which a guide wire can be inserted.
  • the proximal connecting portion 60 includes an inner tube 61 positioned inside the linear body 21, an outer tube 62 positioned outside the inner tube 61, and the inner tube 61 and the outer tube.
  • a guide tube 63 sandwiched between 62 is provided. Between the inner tube 61 and the outer tube 62, the proximal end of the linear body 21 and the guide tube 63 are sandwiched and fixed.
  • the shaft portion 24 is slidably disposed inside the guide tube 63. Accordingly, the proximal side connecting portion 60 is movable in the axial direction along the shaft portion 24.
  • An inner surface side of the inner tube 61 is a guide wire lumen 64 into which a guide wire can be inserted.
  • the cross-sectional area perpendicular to the axial direction of the proximal connecting part 60 is larger than the cross-sectional area perpendicular to the axial direction of the shaft part 24.
  • the expanded portion 20 is in an expanded state (see FIG. 3A) in which the diameter is expanded by its own elastic force (restoring force) of the linear body 21 in a natural state where no external force is applied.
  • the proximal side connecting portion 60 slides distally with respect to the shaft portion 24 and approaches the distal side connecting portion 50.
  • the expansion portion 20 is housed in the suction catheter 30 (see FIGS. 1 and 2), and is in a contracted state (see FIG. 3B) that is elastically deformed to reduce the outer diameter.
  • the expansion part 20 is in the contracted state, the proximal side connection part 60 slides proximally with respect to the shaft part 24 and moves away from the distal side connection part 50.
  • the expansion part 20 is located between the proximal taper part 20A located on the proximal side, the distal taper part 20C located on the distal side, and the proximal taper part 20A and the distal taper part 20C. And a central portion 20B.
  • the proximal taper portion 20 ⁇ / b> A has an inner and outer diameter that increases in a tapered shape from the proximal connection portion 60 toward the distal side. In the distal taper portion 20C, the inner and outer diameters increase in a tapered shape from the distal connection portion 50 toward the proximal side.
  • the inner and outer diameters of the central portion 20B decrease in a tapered shape from the proximal taper portion 20A toward the distal taper portion 20C.
  • the central portion 20B is a portion that contacts the inner wall of the blood vessel when the expansion portion 20 expands.
  • part which contacts the blood vessel inner wall when the expansion part 20 expands may be 20 A of proximal taper parts, or 20 C of distal taper parts.
  • the number of the linear bodies 21 is not particularly limited, but is, for example, 4 to 72. Moreover, the conditions for braiding the linear body 21 are not particularly limited.
  • the outer diameter of the linear body 21 can be appropriately selected depending on the material of the linear body 21 and the application of the extended portion 20, and is, for example, 20 to 300 ⁇ m.
  • the constituent material of the linear body 21 is preferably a flexible material.
  • a shape memory alloy stainless steel, tantalum (Ta), titanium (Ti), which has a shape memory effect or superelasticity by heat treatment, White silver (Pt), gold (Au), tungsten (W), polyolefins such as polyethylene and polypropylene, polyamides, polyesters such as polyethylene terephthalate, fluorinated polymers such as ETFE (tetrafluoroethylene / ethylene copolymer), PEEK (poly Ether ether ketone), polyimide, and the like can be suitably used.
  • ETFE tetrafluoroethylene / ethylene copolymer
  • PEEK poly Ether ether ketone
  • polyimide and the like
  • Ni—Ti, Cu—Al—Ni, Cu—Zn—Al, or a combination thereof is preferably used.
  • the structure in which a plurality of materials are combined include a structure in which a core wire made of Pt is coated with a Ni—Ti alloy in order to impart contrast, and a structure in which a core wire made of a Ni—Ti alloy is plated with gold. .
  • the outer diameter of the outer tubes 52 and 62 is not particularly limited. For example, it is 0.3 to 3.0 mm.
  • the inner diameters of the inner tubes 51 and 61 are not particularly limited. For example, it is 0.1 to 2.0 mm.
  • the constituent materials of the inner pipes 51 and 61 and the outer pipes 52 and 62 are not particularly limited.
  • stainless steel can be suitably used.
  • the maximum outer diameter of the expanded portion 20 in the expanded state can be appropriately selected according to the inner diameter of the blood vessel to be applied. For example, it is 1 to 40 mm.
  • the outer diameter of the expanded portion 20 in the contracted state can be appropriately selected according to the inner diameter of the blood vessel to be applied. For example, it is 0.3 to 4.0 mm.
  • the length of the expansion part 20 in the expanded state in the axial direction can be appropriately selected according to the blood vessel to be applied. For example, it is 20 to 150 mm.
  • the closing part 70 is a thin film-like member fixed to the inner peripheral surface on the proximal side of the extension part 20.
  • the closing part 70 closes the gap 21 ⁇ / b> A of the expansion part 20.
  • the closing part 70 can be flexibly deformed following the extended part 20.
  • the closed portion 70 is arranged in a range equal to or less than half of the axial length of the expanded portion 20 in the expanded state so that the applied blood vessel is not completely blocked in the folded state (see FIG. 8) described later.
  • the thickness of the closing part 70 is not particularly limited. For example, it is 0.01 to 0.2 mm.
  • the constituent material of the closing portion 70 is preferably a flexible material.
  • the closing part 70 may be a member having air permeability and liquid permeability.
  • the closing part 70 is fixed to the extension part 20 by dipping.
  • the closing part may be provided on the outer peripheral surface side of the extension part 20.
  • the closing portion may be provided between the inner peripheral surface and the outer peripheral surface of the expansion portion 20, that is, in the space of the gap 21A.
  • the configuration of the closing portion is not limited as long as the air permeability and liquid permeability of the gap 21 ⁇ / b> A can be limited and can be deformed together with the expansion portion 20.
  • the extended portion 20 is located inside the extended portion 20, with the proximal side connecting portion 60 sliding distally with respect to the shaft portion 24, approaching the distal side connecting portion 50. Thereby, it can be in the folded state folded in the axial direction.
  • the inside of the extended portion 20 is a region surrounded by the inner surface of the extended portion 20 and the central axis.
  • the inner surface of the extended portion 20 means the inner surface of a cylindrical body configured by braiding the linear body 21.
  • the extended portion 20 includes a folded portion 25 that is folded back to form an axially proximal end portion, and a folded portion 26 that is folded back and is located on the inner side in the radial direction.
  • the closing part 70 is arranged on the side where the folding part 26 is provided rather than the folding part 25, that is, on the side closer to the proximal side connecting part 60 (center side). That is, the closing part 70 is arranged only in part in the range from the folded part 25 to the folded part 26. For this reason, the closing part 70 is partially arranged with respect to the expansion part 20 when viewed from the axial direction of the shaft part 24 in the folded state. In the folded state, the maximum outer diameter of the closing portion 70 is smaller than the maximum outer diameter of the expansion portion 20. Thus, the closure 70 partially occludes the applied blood vessel and is not completely occluded.
  • the distance between the proximal side connecting portion 60 and the distal side connecting portion 50 can be set as appropriate.
  • the distance between the proximal connection part 60 and the distal connection part 50 may be different depending on the inner diameter of the blood vessel to be applied.
  • the closing part 70 may contact the inner peripheral surface of the distal part of the expansion part 20, it does not need to contact.
  • the extended portion 20 changes from the expanded state to the folded state at least a part of the closing portion 70 is turned over. A certain amount of force is required to return the closed portion 70 from the inverted state to the original state (see FIG. 7). For this reason, the extended part 20 and the closing part 70 in the folded state have a certain degree of shape stability.
  • the inner peripheral surfaces of the folded portion 25 of the extended portion 20 do not overlap with each other. Therefore, in the folded back part 25, the extended part 20 is folded back in a separated state.
  • the inner surface of the extension part 20 means the inner surface of the cylinder body in which the linear body 21 is braided
  • the outer surface of the extension part 20 means the outer surface of the cylinder body.
  • the expanded portion 20 has a decreasing portion 27 in which the diameter is temporarily decreased from the folded portion 25 toward the proximal side connecting portion 60 located in the expanded portion 20, and an increased diameter in which the diameter is increased from the decreased portion 27.
  • Part 28 As a result, in the folded state, the internal space 29 that is recessed in the axial direction of the extended portion 20 is expanded inside the entrance. In order for the expansion part 20 to return from the folded state to the original state (see FIG. 7), it is necessary for the increase part 28 to pass through the inside of the decrease part 27. For this reason, the extended portion 20 in the folded state has a certain degree of shape stability.
  • the expansion part 20 has a larger diameter at the proximal part than at the distal part, the internal space 29 is widened in the folded state. For this reason, the space which accommodates objects, such as a thrombus, can be secured widely.
  • the suction catheter 30 includes a sheath tube 31, a hub 32, and a kink protector 33, as shown in FIGS.
  • the suction catheter 30 can accommodate the expansion device 10 and can suck and remove a thrombus or the like in a blood vessel from the body.
  • the sheath tube body 31 includes a suction lumen 34 that can accommodate the expansion device 10 and can apply a suction force from the proximal side.
  • the sheath tube 31 has a distal opening 36 where the suction lumen 34 opens at the distal end. Further, the sheath tube 31 has a suction hole 37 in which the suction lumen 34 is opened on the side surface closer to the distal side than the distal opening 36.
  • the sheath tube 31 includes a linear base portion 31A located on the proximal side, a bent portion 38 located on the distal side of the base portion 31A, and a distal tubular portion 31B located on the distal side of the bent portion 38. Have.
  • the bent portion 38 is curved or bent.
  • the distal tubular portion 31B is inclined in a predetermined direction X with respect to the central axis of the base portion 31A.
  • the angle ⁇ at which the distal tubular portion 31B is inclined with respect to the base portion 31A is not particularly limited. For example, it is 10 to 90 degrees, more preferably 30 to 80 degrees, and further preferably 50 to 70 degrees.
  • the suction hole 37 opens in the direction opposite to the direction X in which the distal tubular portion 31B is inclined with respect to the base portion 31A.
  • the suction hole 37 is provided in the bent portion 38. The position where the suction hole 37 is provided may not be on the side opposite to the direction X of the bent portion 38, and may not be the bent portion 38.
  • the sheath tube body 31 includes a reinforcing portion 39 that reinforces a portion where the suction hole 37 is provided.
  • the reinforcing portion 39 is provided in a range including the suction hole 37 of the sheath tube body 31. Therefore, the reinforcing portion 39 constitutes an edge portion of the suction hole 37.
  • the reinforcement part 39 suppresses the bending and crushing of the sheath tube body 31 in which the rigidity is lowered by providing the suction hole 37. For this reason, the suction catheter 30 can suppress a decrease in operability and can appropriately maintain the suction force.
  • the distal opening 36 can accommodate and hold a proximal connecting portion 60 located on the proximal side of the expanded portion 20 in the expanded state.
  • the distance L1 (see FIG. 9) from the distal opening 36 of the suction hole 37 is preferably equal to or longer than the axial length L2 (see FIG. 3) of the proximal connecting portion 60.
  • the inner diameter of the suction lumen 34 is larger than the outer diameter of the proximal connection portion 60 so that the proximal connection portion 60 can slide in the axial direction and the rotation direction within the suction lumen 34.
  • the clearance between the inner peripheral surface of the suction lumen 34 and the outer peripheral surface of the proximal side connection portion 60 when the proximal side connection portion 60 is inserted into the suction lumen 34 is not particularly limited. For example, it is 0.1 to 1 mm, more preferably 0.2 to 0.6 mm, and still more preferably 0.25 to 0.4 mm. If the clearance is too small, the proximal connecting portion 60 cannot slide within the suction lumen 34. If the clearance is too large, the proximal connecting portion 60 cannot satisfactorily block the suction lumen 34 and it is difficult to concentrate the suction force on the suction hole 37.
  • the cross-sectional area perpendicular to the axial direction of the suction lumen 34 located in the distal opening 36 is larger than the cross-sectional area perpendicular to the axial direction of the proximal connection part 60. Further, the cross-sectional area perpendicular to the axial direction of the proximal side connecting portion 60 is larger than the cross-sectional area perpendicular to the axial direction of the shaft portion 24. For this reason, when the proximal side coupling part 60 abuts or enters the distal side opening part 36, the distal side opening part 36 is disposed more along the shaft part 24 than when the distal side opening part 36 is arranged along the shaft part 24. The gap (gap) maintained inside the portion 36 is small. Therefore, the radial displacement of the suction catheter 30 with respect to the shaft portion 24 or the proximal side connecting portion 60 is small, and an object can be stably sucked from the suction hole 37.
  • the opening area of the suction hole 37 (the area on the side surface of the sheath tube 31) is larger than the cross-sectional area in the cross section orthogonal to the central axis of the suction lumen 34. That is, the suction hole 37 can be elongated in the axial direction by being provided on the side surface of the sheath tube body 31 and can be larger than the cross-sectional area of the suction lumen 34.
  • all or a part of the suction hole 37 when the proximal side connecting portion 60 is inserted into the distal side opening 36 may be located distal to the folded portion 25.
  • all or a part of the suction hole 37 when the proximal side connecting portion 60 is inserted into the distal side opening 36 may be located distal to the folded portion 25.
  • returning part 25 or the folding part 26 is not provided is located.
  • the expansion part 20 which functions as a filter is located in front of the suction hole 37.
  • the suction hole 37 when the proximal side connecting portion 60 is inserted into the distal side opening 36 may be closer to the proximal side than the folded portion 25. Therefore, the extended portion 20 may not exist in the opening direction of the suction hole 37.
  • the separation distance H (see FIG. 9) from the central axis proximal to the bent portion 38 of the sheath tube 31 to the distal end of the sheath tube 31 is the radius of the folded portion 25 in the folded state. It is more than (the radius of the entrance of the internal space 29).
  • the thrombus can be efficiently sucked from the suction hole 37 even when there is a flow.
  • the bending position of the sheath tube body 31 may change along the shape of the expansion portion 20.
  • the expansion part 20 may deform
  • the closing portion 70 is located on the distal side of the site where the distal side opening 36 of the suction catheter 30 is provided. Since the closed portion 70 restricts the flow in the blood vessel, the flow in the blood vessel is restricted in the vicinity of the distal opening 36 of the suction catheter 30, and the thrombus floats without sticking to the expanded portion 20. Therefore, it is less necessary to apply a strong suction force in this region. For this reason, the distal side opening 36 is closed by the proximal side connecting portion 60, and instead, the suction force can be concentrated on the suction hole 37 that requires a strong suction force.
  • the hub 32 is fixed to the proximal end of the sheath tube 31.
  • the hub 32 includes a hub opening 35 that communicates with the suction lumen 34 as shown in FIGS.
  • the hub opening 35 can connect the Y connector 190 including the side tube 191.
  • the syringe 180 that generates negative pressure can be communicated with the hub opening 35 in a state where a long device (for example, the shaft portion 24) is inserted.
  • the thrombus dissolving agent can be injected from the syringe 180 into the lumen of the sheath tube 31.
  • the kink protector 33 is a flexible member that covers the connecting portion of the sheath tube 31 and the hub 32. The kink protector 33 suppresses kinking of the sheath tube body 31.
  • the constituent material of the sheath tube 31 is not particularly limited.
  • polyolefin such as polyethylene, polypropylene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, polyvinyl chloride, polystyrene, polyamide, polyimide, or a combination thereof Etc.
  • the sheath tube 31 may be composed of a plurality of materials, and a reinforcing member such as a wire may be embedded therein.
  • the constituent material of the reinforcing portion 39 is preferably harder than the constituent material of the sheath tube 31.
  • stainless steel can be suitably used.
  • the pressing shaft 40 is a tube that can be accommodated in the suction lumen 34 of the suction catheter 30.
  • the pressing shaft 40 includes an extrusion lumen 41 into which the shaft portion 24 of the expansion device 10 can be inserted.
  • the inner diameter of the pushing lumen 41 is smaller than the outer diameter of the proximal side connecting portion 60 of the expansion device 10. For this reason, the proximal side connection part 60 cannot enter into the extrusion lumen 41. Therefore, the proximal side connection part 60 can be pressed to the distal side by the distal end face of the pressing shaft 40.
  • the crushing device 100 includes a long drive shaft 110 that is rotationally driven, a slide portion 111 that is slidable with respect to the drive shaft 110, and a crushing portion 140 that is rotated by the drive shaft 110. It has.
  • the crushing device 100 further includes a rotation drive unit 150 including a drive source (for example, a motor) that rotates the drive shaft 110, a guide wire tube 170 into which a guide wire can be inserted, and a guide wire tube 170. And a hub 160 provided at the rear end.
  • the drive shaft 110 can be accommodated in the suction catheter 30 via the Y connector 190.
  • the proximal end of the drive shaft 110 is located at the rotational drive unit 150.
  • the drive shaft 110 can be reciprocated along the circumferential direction by the rotation drive unit 150.
  • the drive shaft 110 is not limited to one that reciprocates, and may be one that rotates in one direction.
  • the guide wire tube 170 is provided in the hollow interior of the drive shaft 110 from the distal end to the hub 160.
  • the guide wire tube 170 has a guide wire lumen into which a guide wire can be inserted.
  • the crushing part 140 is provided at the distal part of the drive shaft 110.
  • the crushing unit 140 includes a plurality of (six in this embodiment) wire 141.
  • Each wire 141 is curved three-dimensionally.
  • the number of the wire 141 is not specifically limited.
  • Each wire 141 is twisted in the same circumferential direction along the axial direction of the drive shaft 110.
  • a proximal end portion of each wire 141 is fixed to a slide portion 111 slidable with respect to the drive shaft 110.
  • the distal end portion of each wire 141 is fixed to a fixing portion 112 that is fixed to the drive shaft 110.
  • the fixing position of each wire 141 with respect to the fixing part 112 and the slide part 111 is aligned in the circumferential direction.
  • each wire 141 is curved is aligned in the circumferential direction at a position away from the drive shaft 110 in the radial direction.
  • the crushing part 140 has a uniform bulge in the circumferential direction as a whole.
  • the crushing part may be a laser cut pipe such as a stent as well as a wire.
  • the wire 141 which comprises the crushing part 140 is comprised by the metal thin wire which has flexibility. Until the drive shaft 110 is inserted into the target site, the crushing portion 140 is in a state of being housed in the suction catheter 30. When the suction shaft 30 is slid proximally with respect to the drive shaft 110 after the drive shaft 110 is inserted to the target site, the crushing portion 140 is exposed to the outside of the suction catheter 30 and expands. For this reason, the wire 141 is preferably formed of a material having shape memory properties.
  • a method of using the suction system 1 and the crushing device 100 according to the present embodiment is a case where a thrombus (object) in a blood vessel (biological lumen) is sucked and removed while referring to the flowchart shown in FIG. This will be described as an example.
  • an introducer sheath (not shown) is inserted percutaneously into the blood vessel on the upstream side (proximal side) of the blood vessel thrombus 300, and the guide wire 90 is inserted into the blood vessel via the introducer sheath. insert.
  • the guide wire 90 is pushed forward to reach the distal side of the thrombus 300.
  • the suction system 1 in which the expansion device 10 and the pressing shaft 40 are accommodated in the suction catheter 30 is prepared.
  • a Y connector 190 is connected to the hub 32 of the suction catheter 30.
  • the expansion part 20 and the auxiliary expansion part 80 are disposed at a position close to the distal end portion of the sheath tube 31 and are constrained in a contracted state.
  • the shaft portion 24 protrudes proximally from the hub opening 35 of the hub 32 through the Y connector 190.
  • the proximal end portion of the guide wire 90 positioned outside the body is inserted into the guide wire lumens 54 and 64 (see FIG. 7) of the suction system 1. Subsequently, as shown in FIG. 11A, the suction system 1 is made to reach the distal side of the thrombus 300 along the guide wire 90 (step S10). In addition, in order to make the guide wire 90 reach the distal side of the thrombus 300, a separately prepared support catheter can also be used.
  • the suction catheter 30 is moved to the proximal side while suppressing the movement of the pressing shaft 40 by hand.
  • the distal end portion of the pressing shaft 40 contacts the proximal side connecting portion 60.
  • assistant expansion part 80 in the blood vessel can be adjusted arbitrarily.
  • the suction catheter 30 moves proximally with respect to the pressing shaft 40, the auxiliary expansion part 80, the expansion part 20, and the closing part 70 are sequentially released from the sheath tube 31.
  • the auxiliary expansion portion 80 expands by its own restoring force, bites into the blood vessel while expanding the blood vessel, and is firmly fixed to the blood vessel.
  • the distal side connection part 50 moves so as to approach the proximal side connection part 60.
  • the expansion part 20 expands to an optimal magnitude
  • the pressing shaft 40 is moved to the distal side, and the proximal side connecting portion 60 is pushed to the distal side by the distal end portion of the pressing shaft 40.
  • the expansion part 20 will be in the return state folded by the folding
  • the closing portion 70 is located on the center side of the folding portion 26 with respect to the folded portion 25, that is, on the side closer to the proximal side connecting portion 60. For this reason, the closed portion 70 does not completely block the blood vessel in the folded state. For this reason, blood flow can be secured and the burden on the living body can be reduced.
  • the maximum outer diameter of the auxiliary extension portion 80 is larger than the maximum outer diameter of the folded portion 25. Further, in the folded state, the maximum outer diameter of the auxiliary extension portion 80 is larger than the maximum outer diameter of the folding portion 26. In the folded state, the maximum outer diameter of the auxiliary extension portion 80 is larger than the maximum outer diameter of the closing portion 70.
  • the extension part 20 When the extension part 20 is folded back, the extension part 20 receives a force in the distal direction. However, since the auxiliary expansion portion 80 is provided on the distal side of the expansion portion 20, the expansion portion 20 is supported by the auxiliary expansion portion 80 and can maintain an appropriate position.
  • the pressure shaft 40 is removed from the living body while leaving the suction catheter 30.
  • the internal space 29 that is recessed in the axial direction of the extended portion 20 is wider than the entrance, the folded state of the extended portion 20 can be stably maintained.
  • the shape of the closed portion 70 that is at least partially turned over is stable, the folded state of the extended portion 20 can be maintained more stably.
  • the closed part 70 receives the force which goes to a distal side from a blood flow, the folded-back state of the expansion part 20 can be maintained more stably.
  • the expanded portion 20 and the auxiliary expanded portion 80 that are in the folded state are preferably located closer to the proximal side (lower limb side) than the merged portion of the vena cava 200 with the renal vein 201.
  • the thrombus 300 is located in the iliac vein 202, for example. As a result, the thrombus 301 that falls off the thrombus 300 can be prevented from flowing into the renal vein 201, and an increase in renal pressure or the like can be suppressed to improve safety.
  • the closing portion 70 partially blocks the blood vessel. Thereby, the blood flow in the blood vessel is reduced. At this time, since the blood vessel is not completely blocked, blood flow can be secured and the burden on the living body can be reduced.
  • the proximal end portion of the shaft portion 24 is inserted into the guide wire lumen of the crushing device 100.
  • the distal portion of the distal portion of the drive shaft 110 including the crushing portion 140 is inserted into the Y connector 190 connected to the suction catheter 30 using the shaft portion 24 as a guide.
  • the drive shaft 110 is pushed forward, and the crushing device 100 is inserted into the proximal side of the thrombus 300 as shown in FIG.
  • the suction catheter 30 is moved to the proximal side, the crushing portion 140 spreads within the blood vessel as shown in FIGS. 14 and 15A.
  • a syringe 180 containing a thrombolytic agent can be connected to the side tube 191 on the proximal side of the suction catheter 30. Then, simultaneously with the destruction of the thrombus 300 by the crushing portion 140, it is possible to push the pusher of the syringe 180 and eject the thrombolytic agent from the distal end portion of the suction catheter 30.
  • the ejection of the thrombolytic agent may be either continuous or intermittent, and the ejection speed and the ejection amount can be arbitrarily changed.
  • the thrombolytic agent In the case where the thrombolytic agent is ejected intermittently, the thrombolytic agent can be sucked while the ejection is stopped. At this time, since the blood flow in the region where the thrombus is formed is reduced, the thrombolytic agent is kept at a high concentration, and the thrombolytic agent exhibits a high effect. The thrombolytic agent may not be used. Further, when the crushing section 140 is rotated and moved in the axial direction, a suction syringe 180 can be connected to the side tube 191 on the proximal side of the suction catheter 30.
  • the pusher of the syringe 180 can be pulled and the thrombus 301 crushed by the suction catheter 30 can also be sucked. It is not necessary to suck the thrombus 301 during crushing.
  • the drive shaft 110 is rotated by the rotation drive unit 150 in a state where the crushing unit 140 has entered the vicinity of the thrombus 300.
  • the crushing portion 140 rotates and crushes the thrombus 300 that has been fixed in the blood vessel (step S13).
  • the thrombus 301 crushed by the crushing section 140 reaches the expansion section 20 located on the downstream side.
  • the gap 21 ⁇ / b> A of the expanded portion 20 in the folded state is partially blocked by the closing portion 70. Therefore, the blood stays in a range that is blocked by the closing portion 70. For this reason, the crushed thrombus 301 becomes a floating state in the staying blood vessel. Then, the blood can pass through the expansion portion 20 through the gap 21 ⁇ / b> A that is not closed by the closing portion 70.
  • the extended portion 20 is folded in a state where the inner surfaces are separated without contacting each other.
  • the expansion part 20 does not overlap at the folded part 25, and the gap 21A of the expansion part 20 can be secured satisfactorily. Therefore, the blood flowing through the gap 21A of the expansion part 20 can be appropriately maintained, and the burden on the living body can be reduced.
  • the inner surfaces of the extended portion 20 do not overlap with each other at the folded portion 25, a wide range of functions as a filter of the extended portion 20 can be secured. That is, when the inner surfaces of the expansion part 20 overlap each other, the expansion part 20 is crushed, and the range in which blood can flow from the outer surface of the expansion part 20 to the inner surface is reduced.
  • the thrombus 301 that has passed through the gap 21A of the expansion portion 20 located outside the closing portion 70 enters the inner surface side from the outer surface side of the expansion portion 20. Then, the thrombus 301 is collected on the inner peripheral surface of the expansion part 20 located on the distal side of the folding part 26 in the folded state (step S14).
  • the expanded portion 20 is in a collapsed state, so that when the thrombus 301 passes through the gap 21A, it passes through the two overlapping gaps 21A simultaneously. To do.
  • the thrombus 301 that has passed through the gap 21A of the expanded portion 20 from the outer peripheral surface side may not be retained on the inner peripheral surface side of the expanded portion 20.
  • the expansion part 20 is folded in a state where the inner peripheral surfaces are separated from each other in the folded part 25, the thrombus 301 that has passed through the gap 21A of the folded part 25 together with the blood flow from the outer peripheral side is 20 is easily held on the inner peripheral surface side.
  • the thrombus 301 can be satisfactorily collected by effectively using both the outer surface and the inner surface of the expanded portion 20 that is doubled by being folded.
  • the thrombus 301 that has passed through the double expanded portion 20 by being folded back is further collected by the auxiliary expanded portion 80 that functions as a filter.
  • the suction catheter 30 is moved to the distal side along the shaft portion 24. As a result, the suction catheter 30 is positioned on the proximal side of the expansion portion 20.
  • the suction syringe 180 is connected to the Y connector 190.
  • the proximal side connection part 60 is inserted in the distal side opening part 36 (step S15). As a result, the distal opening 36 is closed.
  • the pusher of the syringe 180 is pulled while the hub 32 and the Y connector 190 are gripped and rotated. Thereby, a negative pressure can be generated in the suction lumen 34. Since the distal opening 36 is blocked by the proximal connecting portion 60, the suction force can be concentrated on the suction hole 37. The suction hole 37 is located on the distal side of the folded portion 25. And since the expansion part 20 in which the gap 21A is not blocked by the closing part 70 is located in front of the suction hole 37 (in the opening direction), the thrombus 301 collected in the expansion part 20 is effectively sucked. Yes (step S16).
  • the suction hole 37 can be brought closer to the expanded portion 20. For this reason, the thrombus 301 collected in the expansion part 20 can be effectively sucked from the suction hole 37. Further, when the sheath tube 31 is rotated, the bent portion 38 is swung around to rotate the blood, and in some cases, the side surface of the sheath tube 31 is in contact with the expanded portion 20 or the thrombus 301 collected by the expanded portion 20. .
  • the thrombus 301 attached to the expansion portion 20 is separated from the expansion portion 20 due to the flow of blood, the contact of the sheath tube body 31 with the thrombus 301 or the impact force transmitted from the sheath tube body 31 to the expansion portion 20. Can do.
  • the thrombus 301 separated from the expanded portion 20 is effectively sucked from the suction hole 37.
  • the suction hole 37 is located in the convex side of the bending part 38, the suction hole 37 is located in the outer side of rotation because the sheath tube body 31 rotates.
  • the suction hole 37 approaches the expansion part 20 and the thrombus 301 sticking to the expansion part 20, and in some cases, the suction hole 37 can contact the expansion part 20 and the thrombus 301 and effectively suck the thrombus 301 sticking to the expansion part 20. .
  • the closing portion 70 is located on the distal side of the distal opening 36, when the sheath tube 31 rotates, the staying thrombus 301 rotates in a range where the blood flow is restricted by the closing portion 70. To do. As a result, the thrombus 301 moves and is sucked into the suction hole 37. In the range where the flow is restricted by the closing portion 70, the thrombus 301 stays without sticking to the expanded portion 20, so that it can be sucked from the suction hole 37 even if the distal opening 36 is blocked. . That is, in this region, it is less necessary to apply a suction force. Therefore, the suction force can be concentrated on the suction hole 37 by closing the distal opening 36 with the proximal connecting portion 60.
  • the thrombus 301 collected by the expansion part 20 can be effectively sucked from the suction hole 37. Since the opening area of the suction hole 37 is larger than the cross-sectional area of the suction lumen 34, a wide range along the axial direction can be sucked. Further, the thrombus 301 sucked into the suction hole 37 is not easily clogged, and a high suction force can be maintained.
  • the positions of the expansion part 20 and the suction catheter 30 are stabilized by inserting the proximal connection part 60 into the distal opening 36. Thereby, a stable procedure can be provided without depending on the skill of the technician.
  • the sheath tube body 31 can be moved in the axial direction with respect to the proximal side connecting portion 60 within the range of the axial length L2 of the proximal side connecting portion 60 (see FIG. 3). That is, the sheath tube body 31 can be moved within a range in which the proximal side connecting portion 60 does not come out of the sheath tube body 31. In this range, since the distal opening 36 is blocked by the proximal connecting portion 60, the suction force of the suction hole 37 does not decrease. In this range, when the sheath tube body 31 is moved in the axial direction, the suction hole 37 is also moved, and a wide range in the axial direction can be sucked with respect to the expanded portion 20. The thrombus 301 sucked into the suction hole 37 is discharged to the syringe 180 through the suction lumen 34.
  • the closing part 70 since the closing part 70 partially restricts the blood flow, the clot 301 crushed into the staying blood floats. For this reason, the thrombus 301 can be efficiently sucked from the suction hole 37 and removed from the blood vessel. In addition, when blood is flowing, a strong suction force is required to suck the thrombus 301. In the present embodiment, the closing portion 70 restricts the blood flow. For this reason, it becomes easy to make the suction force of the suction hole 37 act, and the thrombus 301 can be sucked more effectively. Therefore, the thrombus 301 attached to the site where the closing part 70 of the expansion part 20 is not provided can also be effectively aspirated and removed.
  • the closing part 70 is arranged closer to the folding part 26 than the folding part 25. For this reason, the closing part 70 is arrange
  • the closed portion 70 does not completely block the blood vessel in the folded state, so that blood flow is secured. For this reason, as shown in FIG. 14, even if the side branch 203 exists in the vicinity of the installation position of the extension part 20 or the auxiliary extension part 80, the thrombus 301 does not easily flow into the side branch 203, and safety is improved.
  • the expansion part 20, the closing part 70 and the auxiliary expansion part 80 receive force from the blood flow and the suction catheter 30.
  • the positions of the extension part 20, the closing part 70 and the auxiliary extension part 80 are appropriately maintained by the auxiliary extension part 80. For this reason, the treatment which collects the thrombus 301 by the suction system 1 and sucks and removes it can be appropriately performed.
  • the suction catheter 30 After completing the suction of the thrombus 301, as shown in FIG. 18, the suction catheter 30 is pushed back and forth while reciprocating. Thereby, the linear body 21 is gradually accommodated inside the suction lumen 34. As a result, the proximal side connecting portion 60 moves proximally within the suction lumen 34 and leaves the distal side connecting portion 50. Then, the expanded portion 20 and the closed portion 70 are reduced in diameter while returning from the folded state, and are accommodated in the suction catheter 30 (step S17). Further, by pushing the suction catheter 30 distally or by pulling the shaft portion 24 proximally, the auxiliary expansion portion 80 is also reduced in diameter and accommodated in the suction catheter 30.
  • the auxiliary expansion part 80 is inclined toward the distal side, it can be smoothly accommodated in the suction catheter 30.
  • the expansion part 20 the closing part 70 and the auxiliary expansion part 80 are accommodated in the suction catheter 30, the thrombus 301 attached thereto can also be accommodated in the suction catheter 30, so that safety is high.
  • the expansion device 10 is removed from the blood vessel together with the suction catheter 30, and the treatment is completed (step S18).
  • the suction system 1 is a system that is inserted into a blood vessel (biological lumen) and can collect and suck the thrombus 301 (object) in the blood vessel.
  • a proximal connection portion 60 to which the shaft portion 24 is fixedly or movably connected, and a suction lumen 34 for movably receiving the shaft portion 24 and applying a suction force from the proximal portion are provided.
  • the suction catheter 30 includes a tubular base portion 31A and a tubular distal portion that is located on the distal side of the base portion 31A and is inclined toward the predetermined direction X with respect to the central axis of the base portion 31A.
  • Distal tubular portion 31B The distal tubular portion 31B has a distal opening 36 into which the proximal connecting portion 60 enters at a distal end, and a side surface more proximal than the distal opening 36.
  • the opening area of the suction hole 37 is larger than the cross-sectional area of the suction lumen 34, and the suction hole 37 is in a direction opposite to the inclination direction X with respect to the base 31A of the distal tubular portion 31B. Open to face.
  • the suction catheter 30 is guided to the expansion portion 20 along the shaft portion 24, and the proximal side coupling portion 60 is inserted into the distal side opening portion 36, so that the distal side opening portion 36 is inserted. Can be at least partially blocked. For this reason, the suction lumen 34 can be blocked by the distal opening 36, and the suction force acting on the suction lumen 34 can be concentrated in the suction hole 37. Therefore, the thrombus 301 collected by the expansion part 20 can be effectively sucked from the suction hole 37.
  • the suction system 1 is used by inserting the proximal connecting portion 60 into the distal opening 36, the positions of the expansion portion 20 and the suction catheter 30 are stable, and a stable procedure that does not depend on the operator. Can provide.
  • the suction lumen 34 is commonly used for housing the shaft portion 24 and sucking the thrombus 301, the inner diameter can be secured as much as possible as compared with the case where a plurality of lumens are provided, and a high suction force can be obtained.
  • the suction force acting on the suction lumen 34 can be concentrated in the suction hole 37 every time the suction lumen 34 shared for housing the shaft portion 24 and sucking the thrombus 301 is blocked by the distal opening 36. it can.
  • the opening area of the suction hole 37 is larger than the cross-sectional area of the suction lumen 34. Accordingly, a wide range along the axial direction of the suction catheter 30 can be sucked, and an object sucked into the suction hole 37 is not easily clogged, and a high suction force can be maintained.
  • the length L2 of the proximal side connecting portion 60 in the direction along the shaft portion 24 is equal to or shorter than the length L1 from the distal opening 36 of the suction catheter 30 to the suction hole 37.
  • the suction catheter 30 has a bent portion 38 at the distal portion.
  • the bending part 38 can be swung around by rotating the suction catheter 30.
  • the blood is rotated by the bending portion 38 that is swung around, and in some cases, the side surface of the sheath tube 31 comes into contact with the expanded portion 20 or the thrombus 301 collected by the expanded portion 20.
  • the thrombus 301 attached to the expansion portion 20 is separated from the expansion portion 20 due to the flow of blood, the contact of the sheath tube body 31 with the thrombus 301 or the impact force transmitted from the sheath tube body 31 to the expansion portion 20. Can do.
  • the thrombus 301 floating by the closing part 70 is also moved by the rotation by the sheath tube 31 and is sucked from the suction hole 37. Therefore, the thrombus 301 can be effectively sucked from the suction hole 37 even when there is a flow.
  • the suction hole 37 is located on the side where the bent portion 38 is convex. Thereby, the suction hole 37 is located outside when the bending portion 38 that rotates to apply the rotational force rotates. For this reason, the thrombus 301 attached to the expanded portion 20 can be effectively sucked from the suction hole 37.
  • the suction catheter 30 has a reinforcing portion 39 that reinforces a portion where the suction hole 37 is provided. Thereby, the suction catheter 30 can be prevented from being bent or crushed at the position where the suction hole 37 is provided. For this reason, the fall of operativity can be suppressed and a suction
  • the suction system 1 has a flexible deformable closing portion 70 that is partially disposed on the expansion portion 20 so as to close the gap 21A of the expansion portion 20. Thereby, the suction system 1 can effectively suck the thrombus 301 collected by the expansion part 20 having the gap 21 ⁇ / b> A and the thrombus 301 whose movement is restricted by the closing part 70 and floating, from the suction hole 37.
  • the closing portion 70 is located on the distal side of the site where the distal opening 36 of the suction catheter 30 is provided in a state where the proximal connecting portion 60 enters the distal opening 36.
  • the suction force is applied on the proximal side of the closing portion 70 because the necessity for applying a strong suction force is low. Instead, the suction force can be concentrated on the suction hole 37.
  • the closing portion 70 is located on the distal side of the distal opening 36 of the suction catheter 30, the distal opening 36 can be effectively closed by the closing portion 70 that is flexibly deformed. is there.
  • the extended portion 20 can be in a folded state in which the expanded portion 20 is folded back in the axial direction so that the proximal portion is located inside the expanded portion 20, and in the folded state, the proximal side connecting portion In the opening direction of the suction hole 37 when 60 enters the distal opening 36, a portion where the closing portion 70 of the expansion portion 20 is not provided is located.
  • a suction force can be effectively applied to the thrombus 301 attached to the expanded portion 20, and the thrombus 301 can be sucked from the suction hole 37 even when there is a flow.
  • the present invention also has a treatment method for collecting and sucking the thrombus 301 (object) in the blood vessel (biological lumen) using the suction system 1 described above.
  • the treatment method includes a step S10 in which a sheath containing the expansion part 20 is inserted into the blood vessel, and pushes the expansion part 20 out of the sheath downstream from the lesioned part in the blood vessel, thereby expanding the expansion part 20 by its own elastic force.
  • Step S11 for placing in the blood vessel step S13 for dropping an object generated in the lesion in the blood vessel from the lesion, and moving the suction catheter 30 to the distal side along the shaft portion 24.
  • the step S15 of inserting the connecting portion 60 into the distal opening 36 and the state where the proximal connecting portion 60 is inserted into the distal opening 36 are maintained while the suction catheter 30 is pivoted with respect to the expansion portion 20.
  • the suction catheter 30 is guided to the expansion portion 20 along the shaft portion 24, and the proximal side coupling portion 60 is inserted into the distal side opening portion 36, so that the distal side opening portion 36 is inserted. Can be at least partially blocked.
  • the suction force acting on the suction lumen 34 can be concentrated in the suction hole 37, and the thrombus 301 collected by the expansion part 20 can be sucked effectively.
  • the said treatment method is performed by inserting the proximal side connection part 60 in the distal side opening part 36, the position of the expansion part 20 and the suction catheter 30 is stabilized, and the stable procedure which does not depend on an operator is performed. Can be provided.
  • the closing part 400 may be arrange
  • proximal side coupling portion 410 in the proximal side coupling portion 410, another extension member 411 may be fixed to a portion where the linear body 21 is fixed. .
  • the proximal side connection part 410 can be lengthened to an axial direction. Therefore, the sheath tube 31 can be moved in the axial direction within the long range of the proximal side connecting portion 410 without reducing the suction force of the suction hole 37.
  • the suction hole 37 may be able to move both in a range surrounded by the closed portion 70 and in a range surrounded by the extended portion 20 where the closed portion 70 is not provided. Thereby, both the thrombus 301 which is surrounded by the closed portion 70 and floats and the thrombus 301 which sticks to the expanded portion 20 can be effectively aspirated.
  • the suction system according to the second embodiment of the present invention is different from the first embodiment only in the configuration of the sheath tube 501 constituting the suction catheter 500, as shown in FIGS.
  • the sheath tube body 501 includes a suction lumen 502 that can accommodate the expansion device 10 (see FIG. 1) and can apply a suction force from the proximal side.
  • the sheath tube 501 includes a linear base portion 503 located on the proximal side, a bent portion 504 located on the distal side of the base portion 503, and a distal tubular portion 505 located on the distal side of the bent portion 504.
  • the bent portion 504 is curved or bent. For this reason, the distal tubular portion 505 is inclined in a predetermined direction X with respect to the central axis of the base portion 503.
  • the angle ⁇ at which the distal tubular portion 505 is inclined with respect to the base portion 503 is not particularly limited.
  • the distal tubular portion 505 has a distal opening 506 that opens the suction lumen 502 at the distal end.
  • the distal opening 506 is inclined with respect to the central axis of the distal tubular portion 505.
  • the distal opening 506 opens in the direction opposite to the direction X in which the distal tubular portion 505 is inclined with respect to the base 503.
  • the length L3 of the distal opening 506 along the axial direction of the distal tubular portion 505 is preferably longer than the length L4 of the proximal connecting portion 60 in the axial direction (see FIG. 26).
  • the distal opening 506 includes a most distal first part 511, a most proximal second part 512, and a third part located between the first part 511 and the second part 512.
  • the part 513 is provided.
  • the inclination angle ⁇ 1 of the first portion 511 with respect to the central axis of the distal tubular portion 505 is larger than the inclination angle ⁇ 3 of the third portion 513 with respect to the central axis of the distal tubular portion 505.
  • the inclination angle ⁇ 1 increases toward the distal side. When the inclination angle ⁇ 1 decreases toward the distal side, the distal end of the first portion 511 becomes thin and sharp. On the other hand, when the inclination angle ⁇ 1 increases toward the distal side, the distal end of the first portion 511 does not become too thin.
  • the inclination angle ⁇ 2 of the second portion 512 with respect to the central axis of the distal tubular portion 505 is once larger than the inclination angle ⁇ 3 from the third portion 513 toward the proximal side, and then becomes smaller.
  • the edge 514 at the proximal end of the second portion 512 becomes thinner toward the proximal side. Note that, as in the modification shown in FIG. 25, the edge portion that narrows toward the proximal side may not be provided at the proximal end portion of the second portion 512.
  • the expansion portion 20 is installed in the living body lumen using the sheath tube body 501 of the suction catheter 500.
  • the thrombus 300 is crushed by the crushing device 100.
  • the expansion part 20 is demonstrated as a thing in which the closing part 70 is not provided.
  • the crushing device 100 is removed from the suction catheter 500.
  • the suction catheter 500 is moved to the distal side along the shaft portion 24. Accordingly, as shown in FIG. 26, the distal opening 506 abuts on the proximal connecting portion 60 located on the proximal side of the expanded portion 20 in the expanded state.
  • the second portion 512 or the edge portion 514 see FIG.
  • the pusher of the syringe 180 is pulled. Thereby, a negative pressure can be generated in the suction lumen 502. Thereby, the thrombus 301 can be aspirated from the distal opening 506.
  • the proximal side connection part 60 abuts on the distal side opening 506, the positions of the expansion part 20 and the suction catheter 500 are stabilized, and a stable technique independent of the operator can be provided.
  • the pusher of the syringe 180 can be pulled while holding the hub 32 and the Y connector 190 and rotating the suction catheter 500. Thereby, a wide range of the extended portion 20 can be sucked.
  • the sheath tube body 501 is bent at the bent portion 504. Further, the distal opening 506 opens in the direction opposite to the direction X in which the distal tubular portion 505 is inclined with respect to the base 503. For this reason, the shaft portion 24 is easily guided to the second portion 512 located on the proximal side of the distal opening 506 as shown in FIGS. Further, the edge 514 on the proximal side of the second portion 512 is thin. For this reason, when the suction catheter 500 is moved using the long shaft portion 24 as a guide, the shaft portion 24 enters the narrow edge 514 of the distal opening 506. Thereby, a wide range on the distal side of the distal opening 506 is secured without being obstructed by the shaft portion 24.
  • the distal opening 506 opens in the direction opposite to the direction X in which the distal tubular portion 505 is inclined, when the shaft portion 24 enters the narrow edge 514, the distal opening 506 506 tends to face the distal side. Further, the shaft portion 24 is disposed so as to be biased outward in the radial direction of the proximal side connecting portion 60. For this reason, the distal side opening 506 is likely to be located on the opposite side of the proximal side connecting portion 60 with the shaft portion 24 interposed therebetween. For this reason, the thrombus 301 collected by the expansion part 20 can be effectively sucked from the distal opening 506.
  • the opening area is larger than the cross-sectional area of the suction lumen 502. For this reason, a wide range can be sucked. Further, the thrombus 301 sucked into the distal opening 506 is not easily clogged, and a high suction force can be maintained. When a thrombus 301 larger than the cross-sectional area of the suction lumen 502 is sucked from the distal opening 506, the thrombus 301 collapses due to the negative pressure in the suction lumen 502 and is transported through the suction lumen 502.
  • the length L3 of the distal opening 506 along the axial direction is longer than the length L4 of the proximal connecting portion 60 along the axial direction.
  • the length L3 of the distal opening 506 is equal to or shorter than the length L5 from the proximal portion of the proximal connecting portion 60 to the extended portion 20 located on the most distal side of the internal space 29. This makes it difficult for the distal end of the distal tubular portion 505 to enter the gap 21 ⁇ / b> A of the expansion portion 20. For this reason, the interference between the suction catheter 500 and the expansion part 20 can be suppressed, and safety can be improved.
  • the distal end of the first portion 511 of the distal opening 506 increases toward the distal side, the distal end of the first portion 511 is not too thin. . For this reason, the distal end of the distal tubular portion 505 is less likely to enter the gap 21 ⁇ / b> A of the expansion portion 20. For this reason, the interference between the suction catheter 500 and the expansion part 20 can be suppressed, and safety can be improved.
  • extension part 20 can be in a folded state in which the extension part 20 is folded back in the axial direction so that the proximal part is located inside the extension part 20. For this reason, the thrombus 301 can be effectively aspirated by the aspiration catheter 500 after the thrombus 301 is effectively collected by the folded back expanded portion 20.
  • the distal opening 506 When the extended portion 20 is in the folded state, all or a part of the distal opening 506 when the distal opening 506 abuts on the proximal connecting portion 60 is located more distally than the folded portion 25. To do. Thereby, the expansion part 20 which functions as a filter is located in front of the distal opening 506. For this reason, the thrombus sticking to the expansion part 20 can be efficiently sucked from the distal opening 506. In the folded state, the distal opening 506 may be closer to the proximal side than the folded portion 25.
  • the suction system according to the third embodiment of the present invention is different from the first embodiment only in the configuration of the sheath tube 601 and the expansion device 610 constituting the suction catheter 600, as shown in FIG.
  • the sheath tube body 601 includes a suction lumen 602 that can accommodate the expansion device 610 and can apply a suction force from the proximal side.
  • the sheath tube 601 is a straight tube and does not have an opening on the side surface.
  • the sheath tube 601 is linear, but may include a bent portion on the distal side.
  • the sheath tube 601 has a distal opening 603 at which the suction lumen 602 opens at the distal end.
  • the distal opening 603 has an inner diameter that is large enough for the proximal connector 60 of the dilator 10 to enter. Since the sheath tube 601 does not have an opening on the side surface, the suction force can be concentrated on the distal opening 603.
  • the expansion device 610 does not include the closing portion 70 in the expansion portion 20.
  • the expansion device 610 is the same as the expansion device 10 of the first embodiment except that the expansion device 610 is not provided.
  • the outer diameter of the proximal side connecting portion 60 is larger than the outer diameter of the shaft portion 24. Further, the central axis of the proximal connecting part 60 is separated from the central axis of the part connected to the proximal connecting part 60 of the shaft part 24. That is, the proximal side connection part 60 and the shaft part 24 are not coaxial.
  • the expansion portion 20 is installed in the living body lumen using the sheath tube body 601 of the suction catheter 600.
  • the thrombus 300 is crushed by the crushing device 100.
  • the crushed thrombus 301 is collected by the expansion unit 20.
  • the crushing device 100 is removed from the suction catheter 600.
  • the suction catheter 600 is moved to the distal side along the shaft portion 24. As a result, the distal opening 603 is located on the proximal side of the proximal connecting portion 60.
  • the thrombus 301 is sucked into the suction lumen 602 from the distal opening 603.
  • the suction force of the distal opening 603 may be insufficient to peel the thrombus 301 from the expansion part 20. Therefore, at least a part of the thrombus 301 remains attached to the expanded portion 20.
  • the shaft portion 24 is pulled to move the proximal connecting portion 60 to the proximal side.
  • Proximal side connection part 60 moves from position P1 to position P2, for example.
  • the proximal side connection part 60 does not enter the distal side opening part 603.
  • the shaft portion 24 is pushed to move the proximal connecting portion 60 to the distal side.
  • the proximal side connection part 60 moves from the position P2 to the position P1, for example.
  • the proximal side connection part 60 reciprocates in the axial direction, at least a part of the thrombus 301 attached to the expansion part 20 floats away from the expansion part 20 to the proximal side. For this reason, the thrombus 301 separated from the expansion part 20 is sucked into the suction lumen 602 from the distal opening 603.
  • the proximal side connection part 60 repeats reciprocation between the position P1 and the position P2
  • the thrombus 301 is sequentially separated from the expansion part 20 and is sequentially sucked from the distal side opening part 603.
  • the thrombus 301 may remain in the expanded portion 20 after the reciprocating movement of the proximal side connecting portion 60 is repeated between the position P1 and the position P2.
  • the proximal connecting portion 60 in a state where the position of the distal opening 603 is fixed, the proximal connecting portion 60 is reciprocated in the axial direction with an amplitude A2 longer than the amplitude A1 between the position P1 and the position P2. .
  • the proximal side connecting portion 60 reciprocates between the position P1 and the position P3.
  • the thrombus 301 attached to the expanded portion 20 is easily moved away from the expanded portion 20 and easily separated.
  • the proximal side connecting portion 60 may repeat reciprocating movement only by fixed amplitude (for example, amplitude A1 or amplitude A2), without changing an amplitude.
  • the amplitude at which the proximal side connecting portion 60 reciprocates may not be changed by the two amplitudes L1 and L2, but may be changed by a larger number of amplitudes.
  • the expansion device 610 is accommodated in the suction catheter 600 and removed from the blood vessel, and the treatment is completed.
  • the proximal side connecting portion 60 is moved in a state where the position of the distal side opening portion 603 is fixed.
  • the distal side opening portion 603 may be moved in the axial direction.
  • the expansion portion 20 is installed in the living body lumen using the sheath tube body 601 of the suction catheter 600.
  • the thrombus 300 is crushed by the crushing device 100.
  • the crushed thrombus 301 is collected by the expansion unit 20.
  • the crushing device 100 is removed from the suction catheter 600.
  • the suction catheter 600 is moved to the distal side along the shaft portion 24.
  • the distal opening 603 is located near the proximal connecting part 60 and on the proximal side of the proximal connecting part 60.
  • the thrombus 301 is sucked into the suction lumen 602 from the distal opening 603.
  • the small thrombus 301 can move the suction lumen 602 proximally through the distal opening 603.
  • the large thrombus 301 cannot pass through the distal opening 603 and is adsorbed by the distal opening 603 to block the distal opening 603.
  • the shaft portion 24 is pushed to move the proximal connecting portion 60 to the distal side.
  • the proximal side connection part 60 is pulled out from the distal side opening part 603.
  • the distal opening 603 sucks a new thrombus 301 and is blocked by the large thrombus 301.
  • the reciprocating movement of the proximal side connecting portion 60 is repeated while negative pressure is applied to the suction catheter 600 by the syringe 180.
  • the operation of pushing the thrombus 301 into the suction lumen 602 by the proximal side connecting portion 60 can be repeated.
  • the thrombus 301 can be effectively removed while being deformed or destroyed.
  • the expansion device 610 is accommodated in the suction catheter 600 and removed from the blood vessel, and the treatment is completed.
  • the proximal side connection part 60 and the distal side opening part 603 should just move relatively. Therefore, the proximal side connection part 60 may be fixed and the distal side opening part 603 may be moved in the axial direction. Moreover, you may move both the proximal side connection part 60 and the distal side opening part 603. FIG. Moreover, the amplitude of the reciprocating movement of the proximal side connecting portion 60 in the axial direction may change. Moreover, you may apply the usage method demonstrated in 3rd Embodiment to the suction system which concerns on 1st, 2nd embodiment.
  • the present invention is not limited to the above-described embodiment, and various modifications can be made by those skilled in the art within the technical idea of the present invention.
  • the first, second, and third embodiments have a structure in which the suction system is accessed from the upstream side of the affected area, but may be configured to be accessed from the downstream side of the affected area.
  • the living body lumen into which the suction system is inserted is not limited to a blood vessel, and may be, for example, a vascular tube, a ureter, a bile duct, a fallopian tube, a hepatic tube, or the like.
  • the device inserted in the blood vessel along the shaft part 24 is the crushing device 100 provided with the crushing part 140, if an object can be crushed, it will be inserted.
  • the configuration of the device to be used is not limited.
  • the suction catheter 30 is used for the sheath for accommodating the expansion part 20 and the closure part 70, and conveying to the target position.
  • the sheath for accommodating the expansion part 20 and the closing part 70 and transporting them to the target position may be a device different from the suction catheter 30.
  • the proximal connecting portion 60 located on the proximal side of the expansion portion 20 is slidable with respect to the shaft portion 24 and located on the distal side.
  • the distal connection portion 50 is connected to the shaft portion 24 (see FIG. 8).
  • the proximal side coupling portion located on the proximal side of the expansion portion 20 is coupled to the shaft portion 24, and the distal side coupling portion located on the distal side of the expansion portion 20 slides relative to the shaft portion 24. It may be movable.
  • being connected with the shaft part 24 is not limited to being fixed with respect to the shaft part 24, and includes being connected to be relatively rotatable and movable.
  • the expansion part 20 may not be folded back.
  • the sheath tube does not have to be provided with a bending portion.
  • a plurality of suction holes may be provided.
  • 503 base, 505 distal tubular section, 511 first part, 512 second part, 513 third part, 514 edge, L3 length of the distal opening, L4 is the length of the proximal connection part, L5 length from the proximal connection part to the extension part, X tilt direction, ⁇ 1 angle of inclination of the first part, ⁇ 2 The inclination angle of the second part, ⁇ 3 The inclination angle of the third part.

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Abstract

L'invention concerne un système d'aspiration et un procédé de traitement grâce auxquels il est possible d'éliminer efficacement des objets s'écoulant à l'intérieur d'une lumière biologique et de fournir une procédure stable. Un cathéter d'aspiration (500) est inséré à l'intérieur d'un vaisseau sanguin et utilisé pour aspirer un caillot sanguin (301) à l'intérieur dudit vaisseau sanguin, ledit cathéter d'aspiration (500) comprenant une partie de base tubulaire (503), et une partie de tube distale tubulaire (505) qui est située du côté distal de la partie de base (503) et est inclinée vers une direction prescrite (X) par rapport à l'axe central de la partie de base (503), la partie de tube distale (505) comprenant, sur sa partie d'extrémité distale, une partie d'ouverture distale (506) qui est inclinée par rapport à l'axe central de la partie de tube distale (505), et la partie d'ouverture distale (506) s'ouvre vers une direction opposée à la direction d'inclinaison (X) de la partie de tube distale (505) par rapport à la partie de base (503).
PCT/JP2017/030306 2016-08-29 2017-08-24 Cathéter d'aspiration, système d'aspiration et procédé de traitement WO2018043279A1 (fr)

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US11197685B2 (en) 2018-11-15 2021-12-14 Progressive NEURO, Inc. Apparatus, system, and method for vasculature obstruction removal
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JP7483409B2 (ja) 2019-03-04 2024-05-15 ニューラヴィ・リミテッド 作動血塊回収カテーテル
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US11172946B2 (en) 2018-10-26 2021-11-16 Progressive NEURO, Inc. Apparatus, system, and method for vasculature obstruction removal
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US11723678B2 (en) 2018-11-15 2023-08-15 Progressive NEURO, Inc. Apparatus, system, and method for vasculature obstruction removal
US11857211B2 (en) 2019-01-08 2024-01-02 Progressive NEURO, Inc. Apparatus, system, and method for vasculature obstruction removal
WO2021060157A1 (fr) * 2019-09-25 2021-04-01 オリンパス株式会社 Électrode avec conduit et outil de traitement

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